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The failures of abstinence-only

OVER THE PAST year, Planned Parenthood's educators have been hearing a frightening new question from Massachusetts high school students: Why bother using condoms when you have sex, since they don't work anyway?


We teach sex education classes in more than 50 of the Commonwealth's high schools every year, so we are used to answering tough questions. We are used to combating myths. But we are not used to students challenging established scientific facts about the effectiveness of condoms.

Ask students where they are getting this information, and they almost always point to an abstinence-only-until-marriage program.

Abstinence-only education has been in the news recently. In his State of the Union address, President Bush proposed doubling federal funding for it. But many people are surprised when they find out what the "only" in "abstinence-only" really means.

It means, under the federal regulations governing these programs, that educators are prohibited from telling students that condoms can prevent pregnancy and HIV/AIDS.

They cannot discuss the facts even when talking to sexually active teens who are at high risk of contracting HIV. According to these guidelines, condoms and other forms of contraception can only be discussed to emphasize their failure rates. Some programs, for example, provide students with two lists: one of diseases they can get when having unprotected sex and another of diseases they can get when using a condom. The lists are the same. Both include HIV, but the fact that condoms are roughly 96 percent effective in preventing the spread of this disease is nowhere to be found.

This marks a radical departure from traditional sex education, which focuses on a comprehensive approach to preventing teen pregnancy, HIV, and other sexually transmitted diseases. It also makes abstinence-only programs dangerous.

Perhaps that is why, despite the backing of President Bush, recent polls show that only 15 percent of Americans favor the abstinence-only approach. But do the programs work?

It's not easy to answer that question definitively, since no effort has been made at the federal level to rigorously evaluate their effectiveness. The Department of Health and Human Services hired Mathematica Policy Research Inc. in the late 1990s to complete a federal assessment but directed researchers to evaluate only 11 handpicked programs, instead of a random sample of the hundreds of federally funded programs. Further, Mathematica's soon-to-be-released interim report will not evaluate any of the programs for behavioral change. In other words, it won't tell us whether these programs are leading kids to have less sex or more sex, or whether that is affecting rates of pregnancy and infection.

Meanwhile, studies that looked at behavioral change have produced results that are hardly reassuring.

In Minnesota, for example, a recent study of the state's abstinence-only program, Education Now and Babies Later, found that sexual activity among participating students doubled between 2001 and 2002 and that the number who said they would probably have sex during high school nearly doubled, as well.

In 2001, researchers at Columbia University found that, although a limited number of students who signed so-called "virginity pledges" delayed sexual activity for more than a year, they were also one-third less likely to use protection when they did have sex -- a massive failure from a public health perspective. This year, the same researchers found that students who signed the pledges contracted sexually transmitted diseases at roughly the same rate as students who did not.

In the public health community, this raises serious concerns about why the federal government is spending millions of dollars on programs that have not been proven effective. It is even more disturbing, given the research findings on comprehensive sex education programs. Numerous rigorous, peer-reviewed studies have demonstrated that these programs help teens delay sexual activity, use contraceptives when they do become sexually active, and reduce their number of partners.

Nonetheless, for the first time, more federal and state funding is available in Massachusetts for abstinence-only than for comprehensive sex education.

Middle and high school students rely on health education programs to teach them scientifically established facts. Federal policies that promote the dissemination of incomplete and inaccurate information betray this public trust and should be abandoned.

Naomi Ninneman is director of education at Planned Parenthood League of Massachusetts.

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